Module 3 part 1

Question 1

planned weight loss goal

Answer 1

500 caloric def. daily
Will lose 1 lb per week

Question 2

Unplanned parameters

whats moderate?
whats severe?

Answer 2

• 5% in a month
• 10% in 6 months
• 11-19% moderate protein-calorie
• 20%+ severe

Question 3

What is overnutrition

Answer 3

• eat more calories than burn.
• 500 per day excess will gain 1 lb in a week

Question 4

how many calories is 1 lb of fat

Answer 4

3,500 calories

Question 5

Define malnutrition

Answer 5

undernutrition (stunting, wasting, underweight, micronut def) and overnutrition (overweight/obese).

Question 6

Individuals at risk for undernutrition

Answer 6

• Alcoholics
• Behavioral/mental health issues
• Children
• Chronically/acutely ill individuals
  * Decreased cognitive function
• Elderly
• Illiterate individuals
• Individuals with disabilities
• Individuals who lack financial means
  ** Traumatic brain injury**
• Substance abusers

Question 7

a diagnosis of malnutrition:

Answer 7

1. Low energy intake.
2. Weight loss.
3. Loss of muscle mass.
4. Loss of subcutaneous fat.
5. Fluid accumulation.
6. Diminished hand grip strength.
   If the individual has at least two of the five criteria, a diagnosis of malnutrition can be made

Question 8

If you have malnutrition, what happens to your body?

Answer 8

higher risk for disease/illness, delayed healing, poorer functional status, recovery, and a lower survival rate.

-you have less energy reserves so this makes sense

Question 9

What test is ordered when someone has caloric deficit?

Answer 9

CBC to test for anemia, lipid disorders and nutritional status

Question 10

RBC refresher:

What is hematocrit, MCV, MCH, RDW, platelet count, RBC count, hemoglobin?

Answer 10

• hematocrit is #/100 (%) proportion of blood that is rbcs
• MCV is size of rbc - low if not much hemoglobin or iron to fill the rbc up, or some kind of spleen chomping it issue
• MCH is avg hemoglobin in the average red cell. not the AMOUNT of hemoglobin.
• RDW is how diverse the sizes of rbc are
• platelet count (thrombocytes)
• RBC count is the AMOUNT of RBCs

Question 11

what vitamen is folate

Answer 11

FOLATE = green folgate
B9

Question 12

where is folate absorbed

Answer 12

Intestine and liver

Question 13

Where is ferritin made

Answer 13

• liver, spleen, bone marrow
• storage should be equal to circulation

Question 14

Prealbumin is what? What is serum albumin significance

Answer 14

• prealbumin is produced by the liver. used to assess protein def.
• Serum albumin measures protein found in the blood LONG TERM

Question 15

What program can deliver meals

Answer 15

Meals on Wheels

Question 16

cushings disease process

Answer 16

high cortisol
gain a lot of fat/weight in the belly and upper back

Question 17

Anorexia, Ageusia, Dysgeusia definitions

Answer 17

• Anorexia is a decreased appetite.
• Ageusia is the absence of taste.
• Dysgeusia refers to the presence of a metallic, rancid, or foul taste in the mouth.

Question 18

What are the most common food allergies

Answer 18

nuts, fish, milk, eggs, soy products, and wheat.

Question 19

Whats the most common intolerance

Answer 19

lactose

Question 20

is gluten free an allergy or intolerance

Answer 20

intolerance

no wheat, barley, or rye

Question 21

Explain The Malnutrition Screening Tool (MST)

Answer 21

a brief screening by a nurse. if positive, notify MD for dietician referral

Have you lost weight without trying? How much? Decreased appetite?

0 or 1 no risk but repeat weekly
2+ at risk and immediately intervere w/ nutritionist consult

Question 22

Nutrition history, vs 24 hr recall, vs 3 d diary

Answer 22

• 3 d diary is more accurate
• 24 h recall sometimes hard to rememeber
  *24 h recall is subject to recall bias whereas the 3 d diary is recorded right after they eat

Question 23

assessment through direct observation

Answer 23

1. Observe the patient eating during mealtime.
2. Note if the patient is having any difficulty swallowing or feeding himself or herself.
3. Document the percentage (0 through 100 percent) of the meal eaten.

normal is 75% of food eaten or more!

Question 24

can BMI be a health indicator alone?

Answer 24

no. must take diet, physical activity, and family history

Question 25

what is a stadiometer

Answer 25

measures height

Question 26

what is a normal BMI

Answer 26

18.5 to 24.9

Question 27

obese bmi? overweight bmi? underweight bmi?

Answer 27

BMI < 18.5: Underweight range. BMI ≥ 25 to 29.9: Overweight range. BMI ≥ 30: Obese range.

Question 28

Classes of obestiy

Answer 28

Class 1: BMI of 30 to < 35. Class 2: BMI of 35 to < 40. Class 3: BMI of 40 or higher. Class 3 obesity is sometimes categorized as “extreme” or “severe” obesity

Question 29

Name a few anthropometric measurements

Answer 29

height, weight, BMI, abdominal circumference, waist to hip ratio, mid upper arm circumference

Question 30

abdominal circumference procedure steps

Answer 30

1. Stand in front of the patient and palpate the right hip (right ilium) at the top of the right iliac crest to identify the greatest diameter of the abdomen. 2. Place the tape measure around the bare abdomen at the level of the iliac crest, which should also be close to the level of the navel (Fig. 4-5). 3. Pull the tape measure snugly around the abdomen. 4. Take the measurement after the patient breathes normally out (end of expiration). 5. Document the measurement.

Question 31

normal and abnormal abdominal circumference for males and females

Answer 31

Normal is Males: 40 inches or less Females 35 inches or less

Question 32

danger of abdominal fat?

Answer 32

CVD risk factor in adults because it indicates fat deposition on the organs (visceral fat)

Question 33

Waist to hip ratio procedure steps

Answer 33

1. Place tape measure around the narrowest area of the waist between the hips and the **11th rib (**Fig. 4-6). 2. Take measurement after a normal breath at the end of expiration. 3. Record the measurement in inches or centimeters. 4. Place the tape measure around the **widest** point of the **hips** (Fig. 4-6). 5. Record the measurement in inches or centimeters. 6. Calculate the waist-to-hip measurement by dividing the waist measurement by the hip measurement. | waist is over hip ## Footnote also measures central distribution of fat this goes one step further than abdominal circumference. it gets the ratio to the hip as well.

Question 34

normal and abnormal findings for waist to hip ratio

Answer 34

NORMAL FINDINGS Men: Waist ≤ 40 inches (102 cm), WHR ≤ **0.95.** cant be more than this Women: Waist ≤ 35 inches (88 cm), WHR ≤ **0.80.** cant be more than this

Question 35

whats better, pear shape, or apple shape?

Answer 35

pear. pear indicates gluteal femoral obesity. apple indicates abdominal obesity. more indicative of CVD risk

Question 36

Mid upper arm circumference procedure

Answer 36

1. Place the patient in an upright sitting or standing position. If the patient is unable to sit or stand, the MUAC may be taken in the laying position. 2. Remove clothing from the nondominant arm. 3. Ask the patient to bend the nondominant arm. 4. Using the measuring tape, measure from the top of the shoulder (acromion process) to the tip of the elbow (olecranon process) (Fig. 4-9A). 5. Identify the mid-point of measurement and mark the arm at this point. 6. Ask the patient to allow his or her arm to hang by his or her side. Measure the arm at the mid-point mark making sure the tape measure is snug but not tight (Fig. 4-9B). 7. Document the measurement in centimeters (cm).

Question 37

What is the point of measuring arm circumference and what are normal findings

Answer 37

its an alternative to other measurements if the patient is too immobile or ill. Its used to measure skeletal muscle mass and 50% of protein in the body. * 50 percent of the protein stores are in the muscle tissue. *indicator of nutritional status *can be taken laying down

Question 38

Can the patient still eat food that their culture likes

Answer 38

yes try to tailor the diet around it

Question 39

Myplate vs Healthy eating plate

Answer 39

healthy eating plate was dev. by harvord school of public health. expands on myplate. myplate was from USDA (US dept of agriculte)

Question 40

proportion of weight due to water?

Answer 40

60%

Question 41

A higher specific gravity indicates...

Answer 41

....more concentrated urine... and the body is holding onto water so its thirsty.

Question 41

Which electrolytes are imbalanced when someone is dehydrated? and lab values

Answer 41

BUN elevated Na, Cl, K abnormal CBC hematocrit elevated

Question 42

One liter is how many kg? How many lbs?

Answer 42

1 L = 1 kg 1 L = 2.2 lbs 1 kg = 2.2 lbs

Question 43

# A Symptoms of dehydration

Answer 43

* Dry mouth and mucous membranes Irritability or confusion (brain needs water) * Headache * Dizziness (not enough blood circulation to reach brain) * Decreased urine output * Darker urine color * ** Fever** (body can't cool down)

Question 44

Besides the obvious patient education, what about exercise?

Answer 44

* Strength training: Do strength training exercises for all major muscle groups at least two times a week. * Aerobic activity: Get at least 150 minutes of moderate aerobic activity or 75 minutes of vigorous aerobic activity a week, or a combination of moderate and vigorous activity. The guidelines suggest that you spread out this exercise during the course of a week.